Effect of Automated Insulin Delivery System Therapy at Diagnosis on Metabolic Control in Children and Adolescents with Type 1 Diabetes.

introductionThe primary goal of managing type 1 diabetes mellitus (T1D) is to achieve glycemic control and prevent both acute and chronic complications. In recent years, automated insulin delivery (AID) systems, such as the 780G AID system, have significantly improved glycemic control and patient safety. Despite being the most advanced treatment option, AID initiation is often delayed until the honeymoon stage (partial remission phase). This study evaluated the impact of initiating MiniMed™ 780G at diagnosis on metabolic control and glycemic metrics in children newly diagnosed with T1D. It compares early AID initiation with continuous glucose monitoring (CGM) and multiple daily injection (MDI) therapy over a 1-year follow-up period.

methodsThis retrospective study included children and adolescents (age range 0.87-17.72 years) newly diagnosed with T1D between January 2023 and August 2024. Ten patients who were initiated on AID therapy at diagnosis were included, with eight patients completing a 1-year follow-up. Data from these eight patients and seven patients on CGM + MDI therapy were analyzed at baseline and at 3, 6, and 12 months.

resultsThe mean age at diagnosis was 6.98 ± 3.22 years (0.87-9.82) for the AID group and 9.77 ± 4.89 years (3.70-17.72) for the CGM + MDI group (p = 0.14). The AID system was initiated at an average of 3.33 ± 7.73 days (2-23) after diagnosis, while sensor use in the CGM + MDI group began an average of 17.37 ± 8.86 days (1-29) after diagnosis. At 12 months, mean hemoglobin A1c (HbA1c) was 6.10% (43 mmol/mol) in the AID group compared with 7.73% (61 mmol/mol) in the CGM + MDI group. Time in range (TIR) was 79.0% vs. 50.7%, and time above range (TAR) was 13.4% vs. 30.7%, based on 2-week CGM data prior to the 12-month visit (p = 0.02, p = 0.009, p = 0.02). No case of diabetic ketoacidosis or severe hypoglycemia was reported during the follow-up period.

conclusionThis study highlights the potential benefits of initiating AID therapy at the time of diagnosis, offering novel insights into its safety and efficacy in the early management of T1D. These findings suggest that early initiation of AID therapy at the time of diagnosis is feasible and may improve glycemic outcomes.